Flashcards in Amenorrhea, Oligomenorrhea Deck (56):
What is primary amenorrhea
no menses by age 13 in absence of secondary sexual characteristics or NO menses by age 15 with secondary sexual characteristics
What is secondary amenorrhea
no menses for >60mo or 3 cycles after documented menarche
what is oligomenorrhea?
episodic vaginal bleeding occurring at intervals >35d
How do you remember puberty stages
boobs, pubes, flow grow
Tanner stage 3?
Breast; no contour, enlargement of breast and areola
When does sexual differentiation occur in embryology?
What happens when males differential?
Wolffian (mesonephric) ducts; develops into epididymis, vas deferens, seminal vesicle, ejaculatory duct
What do wolffian (mesonephric) ducts differential into?
epididymis, vas deferens, seminal vesicles, ejaculatory duct.
What cells lead to male sexual differentiation?
leydig cells (internal/external) and sertoli cells (shuts down female (internal)) sexual differentiation through MID
how does testosterone break down to di hydrotestosterone?
5 alpha reductase
what happens with 5 alpha reductase deficiency
no external male genitalia (penis, scrotum, prostate)
What is the other name for Mayer-Rokitansky-kuster-hauser syndrome?
What is the pneumonic to remember the male internal genitalia?
SEED (seminal vesicles, ejaculatory duct, epididymis, deferens(vas)
Where do the male internal genitalia derive from?
Wolffian (mesonephric) duct
What is the other name for the mesonephric duct?
wolfian duct (male
What are the structures that derive from the mullein (paramesonephric) ducts)
fallopian tubules, uterus, upper part of vagina
What happens in mullein agensis
primary amenorrhea with FULLY developed secondary sex characteristic.
how do sertoli cells work?
shut down female (internal) sexual characteristics (for men) through MIF
what is the karyotype in androgen insensitivity syndrome?
What is imperforate hymen associated with?
simplest defect that results in primary amenorrhea. May be associated with cyclic pelvic pain and a perirectal mass from sequestration of blood in vagina (hemtocolpos)
What is hematocolpos?
perirectal mass from sequestration of blood in vagina
what is the initial Bloodwork in primary amenorrhea?
bhcg, tsh, FSH, LH, prolactin, pelvis US (do they have a uterus?)
High FSH and primary amenorrhea is what ?
What are the major causes of secondary amenorrhea (aside from pregnancy?)
Anorexia, PCOS, stress, excessive exercise, prolactinoma,
when'd o you get bitemporal hemianopsia?
what is the cause of post d &c amenorrhea?
what physical exam findings coincide with secondary amenorrhea?
hyperandrogen, galactorrhea, low weight, high weight
add total testosterone if you are working up what?
What do you do with a high prolactin?
repeat because often false +ve
What causes false high prolactin?
With high prolactin what do you order?
MRI of pituitary gland (for pituitary adenoma; prolactinoma)
What is the management of HP axis dysfunctino
identify modifiable underlying cuase. Combined OCP to decrease risk of osteoporosis, maintain normal vaginal and breast development (not proven to work)
What is the most common cause of premature ovarian failure?
What is the most important Ix for short stature with a normal growth velocity
Bone age (will be normal in familial and delayed in constitutional)
How do you diagnose PCOS
1) Clinical/biochemical signs of hyperandrogenism 2) ovarian dysfunction (oligo/anovulation or polycystic ovaries) 3) exclusion of other androgen excess or ovulatory disorders
How do you remember PCOS (HAIR-AN)
Hirstusism, hyperandrogenism, infertility, insulin resistance, aconthosis nigricans
what does an increase in LH do to your ovaries
an ovulation then oligomenorrhea, then infertility
What are the short term consequences of PCOS
obesity, infertility, depression, sleep apnea, irregular menses, abnormal lipids, Non alcoholic fatty liver, hirutism/acne, androgenic alopecia, insulin resistance, acanthosis nigricans
What are the long term consequences of PCOS
DM, endometrial CA, cardiovascular disease
does US showing no cyst on ovaries r/o PCOS?
What do you need to include in the workup of PCOS and why?
DHEAS(CAH/adrenal tumour), Cortisol (cushing, cortisol resistance), Prolactin, Tsh, IGF-1 (hyperprolactinemia, thyroid dysfunction, acromegaly)
Why do you test for DHEAS in workup of PCOS?
for endocrine cause (CAH/adrenal tumour)
Why do you test for cortisol in workup of PCOS?
Why do you test for Prolactin, TSH, Free t4, and IGF1 in workup for pCOS?
hyperprolactinemia, thyroid dysfunction, acromegaly
What is the most sensitive test for PCOS?
Free testosterone (DHEAs, androstenedione as well)
A 16 year old woman presents for evaluation of pelvic pain. She has advanced breast and sexual hair development. Her examination is significant for imperforate hymen. A transvaginal ultrasound shows the finding below. A transvaginal ultrasound shows normal female pelvic anatomy. What is this patient’s expected karyotype?
45, XO D. 45,X/46XX
46, XX E. 47XXY
An 17 year old nulligravida presents with primary amenorrhea. Her examination is notable for Tanner stage IV breast and absence of pubic and axillary hair. Also, a blind ending vagina is identified. What is the likely diagnosis in this patient?
Premature ovarian failure
Androgen insensitivity syndrome
Congenital adrenal hyperplasia
normal physiological changes
Androgen Insensitivity syndrome
With Mullerian Agenesis you have pubic hair because ovaries are intact.
In those without menses, which of the following clinical scenarios meets the definition of Amenorrhea?
A 12 year old woman with Tanner stage I breast development
A 16 year old woman with Tanner stage II breast development
A 14 year old woman with Tanner stage III breast development
An 18 year old woman with Tanner stage V breast development and cessation of menses for the last two cycles
E. An 18 year old woman with Tanner stage V breast development and cessation of menses for the forty days
B- 16 year old woman with Tanner stage II breast development
Which of the following chemotherapeutic classes is most damaging to the ovaries?
Gonadotropin releasing hormone (GnRH) analogues
None of the above
Which of the following is the true of Kallmann syndrome?
A. Gonadotropin releasing hormone (GnRH) neurons fail to develop
B. Intact sense of the smell differentiates it from other similar conditions
C. It is a condition that leads to hypergonadotropic hypogonadism
D. It is also associated with other abnormalities such as cerebellar ataxia and midline facial defects.
E. None of the above
.D- It is also associated with other abnormalities such as cerebellar ataxia and midline facial defects
No sense of smell
Which of the following hormones is NOT produced by the anterior pituitary glands?
A 25 yo woman, G3P3, comes to clinic b/c she has not had a menstrual period since giving birth vaginally, to her 3rd child 13 mo ago. This delivery was complicated by postpartum hemorrhage which required dilatation and curettage. She has been breast feeding the infant for 4 months. She has no medical history but states she has a long-standing history of bloating and mood changes that occur with menses. . Examination and review of systems including thyroid, breast and pelvic are normal. Serum TSH, FSH and prolactin are within the reference range. Qualitative serum β-hCG is negative and a progestin challenge shows no withdrawal bleeding.
Which of the following is the most likely diagnosis?
a)Premature ovarian failure
A 19-year-old woman comes to clinic because she has never had a menstrual period. On history taking, she states that she has also had a lifelong inability to differentiate smells. Breast development is Tanner stage 2 and there is sparse pubic and axillary hair. Pelvic examination shows a normal-appearing cervix. Which of the following is the most likely diagnosis?
c)Growth hormone deficiency
d)Hypogonadotropic hypogonadism (Kallmann syndrome)
d)Hypogonadotropic hypogonadism (Kallmann syndrome)
An 18-yo woman comes to clinic b/c she has not had a menstrual period for the past year. Even after a 7-day course of medroxyprogesterone, she did not have withdrawal bleeding. She is not sexually active and has no medical history. She is 157 cm tall and weighs 50 kg. Breasts development is Tanner stage 2, and pubic hair development is Tanner stage 5. Pelvic exam shows a normal vagina, cervix and a prepubertal-sized uterus. Serum studies show FSH of 2 mlU/mL(Low), prolactin and normal TSH . An MRI of the brain shows no abnormalities.
If left untreated over the next 10 yrs, what is this patient at greatest risk for?
e)Coronary artery disease
An 18‐year‐old woman presents with primary amenorrhea. Which one of the following findings best supports the diagnosis of Turner syndrome?
e)Normal external genitalia